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Epinephrine allergy rare

Question:

5/17/2017
Is there a way to test for an allergy to Epinephrine? Patient reports history of hives with Epinephrine.

Answer:

Such reactions are exceedingly rare. Skin testing is difficult due to the vasoconstrictor property of epinephrine. I found the lone abstract below suggesting a hypersensitivity reaction based on a drug lymphocyte stimulation test.

Anesth Prog. 2004; 51(4): 134–137
PMCID: PMC2007490
Allergic reaction to epinephrine preparation in 2% lidocaine: two case reports.
Hikaru Kohase and Masahiro Umino
Abstract
We report 2 cases of hypersensitivity to an epinephrine preparation in local anesthetics which were found by skin tests for local anesthetics. Both patients had uncomfortable episodes to local anesthetics at dental treatment. In both cases, the skin tests showed positive reactions to 2% lidocaine with 1:80,000 epinephrine. Furthermore drug lymphocyte stimulation test revealed positive reaction to epinephrine hydrochloride, epinephrine bitartrate in case 1, whereas in case 2, the drug lymphocyte stimulation test showed positive response to epinephrine bitartrate. Attention should be paid to exogenous epinephrine preparations that have the potential to induce hypersensitivity during dental treatment.

We hope this helps.
Patricia McNally, MD, FAAAAI